Outcomes following transarterial embolization for hepatocellular carcinoma with complete radiologic response

Abstract

Background: To evaluate the long term outcomes of patients who have a complete radiologic response (CRR) following transarterial embolization (TAE) or chemoembolization (DEB-TACE) for hepatocellular carcinoma (HCC). Methods: A previously published prospective randomized controlled trial evaluated the efficacy of TAE vs. DEB-TACE in 101 patients with HCC from December 2007 to April 2012. These patients were followed with computed tomography every 3 months after treatment. From this cohort, we reviewed the outcomes of patients who achieved CRR to determine overall survival (OS), progression free survival (PFS), and cause of death. Results: 38/101 (37.6%) of patients treated with TAE or DEB-TACE obtained CRR, 18/51 in the TAE group and 20/50 in the DEB-TACE group. The median OS of this cohort was 24 m (20.1–27.9), and median PFS was 11 m (6.7–15.3). 37/38 (97%) patients developed intrahepatic (IH) recurrence. 19/38 (50%) patients died due to IH progression of disease and liver failure without radiologic evidence of extrahepatic metastases. 10/38 (26%) patients developed IH recurrence, but died due to ultimate extra-hepatic progression with median time to metastasis of 12m, (range 6–78). 6/38 (16%) patients died of causes other than cancer and cirrhosis. One patient was successfully transplanted, and 2 patients remain alive with disease. Conclusion: Nearly all patients who achieved CRR after TAE or DEB-TACE developed IH recurrence and half of these patients died of IH disease progression or liver failure without evidence of systemic metastases. Patients with advanced HCC who are able to achieve CRR after TAE or DEB-TACE require careful observation for other potential treatments.